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Eye Injuries NEWSLETTER OF THE AMERICAN ORTHOPAEDIC SOCIETY FOR SPORTS MEDICINE SEPTEMBER/OCTOBER 2012 Research Mentoring Grant Available Apply for Traveling Fellowship Sports Medicine Fellowship Match in Full Swing EYE INJURIES www.sportsmed.org SEPTEMBER/OCTOBER 2012 CO-EDITORS EDITOR Brett D. Owens MD EDITOR Daniel J. Solomon MD MANAGING EDITOR Lisa Weisenberger PUBLICATIONS COMMITTEE Daniel J. Solomon MD, Chair Kevin W. Farmer, MD Kenneth M. Fine MD Robert A. Gallo MD Robert S. Gray, ATC David M. Hunter MD Brett D. Owens MD Kevin G. Shea MD Michael J. Smith, MD Robert H. Brophy MD Lance E. LeClere MD BOARD OF DIRECTORS PRESIDENT Christopher D. Harner MD PRESIDENT-ELECT Jo A. Hannafin MD, PhD VICE PRESIDENT Robert A. Arciero MD SECRETARY James P. Bradley MD TREASURER Annunziato Amendola MD UNDER 45 MEMBER-AT-LARGE Jon Sekiya MD UNDER 45 MEMBER-AT-LARGE Matthew Provencher MD OVER 45 MEMBER-AT-LARGE Darren Johnson MD PAST PRESIDENT Robert A. Stanton MD PAST PRESIDENT Peter A. Indelicato MD 2 Team Physician’s Corner EX OFFICIO COUNCIL OF DELEGATES Marc R. Safran MD Blunt Eye Injuries AOSSM STAFF EXECUTIVE DIRECTOR Irv Bomberger MANAGING DIRECTOR Camille Petrick EXECUTIVE ASSISTANT Sue Serpico 1 From the President 15 Traveling Fellowship ADMINISTRATIVE ASSISTANT Mary Mucciante 9 Research News Going to Asia Pacific FINANCE DIRECTOR Richard Bennett 17 Washington Update DIRECTOR OF CORP RELATIONS & IND GIVING Judy Sherr 10 STOP Sports Injuries DIRECTOR OF RESEARCH Bart Mann Campaign Update 18 Orthopaedic Sports DIRECTOR OF COMMUNICATIONS Lisa Weisenberger 12 Society News Medicine Fellowship COMMUNICATIONS ASSISTANT Joe Siebelts STOP SPORTS INJURIES CAMPAIGN DIRECTOR Michael Konstant 20 Upcoming Meetings 12 New Abstract DIRECTOR OF EDUCATION Susan Brown Zahn Submission System and Courses SENIOR ADVISOR FOR CME PROGRAMS Jan Selan EDUCATION & FELLOWSHIP COORDINATOR Heather Heller SPORTS MEDICINE UPDATE is a bimonthly publication of the American Orthopaedic Society for Sports Medicine (AOSSM). The American EDUCATION & MEETINGS COORDINATOR Pat Kovach Orthopaedic Society for Sports Medicine—a world leader in sports medicine education, research, communication, and fellowship—is a national MANAGER, MEMBER SERVICES & PROGRAMS Debbie Czech organization of orthopaedic sports medicine specialists, including national and international sports medicine leaders. AOSSM works closely with many other sports medicine specialists and clinicians, including family physicians, emergency physicians, pediatricians, athletic trainers, and EXHIBITS & ADMIN COORDINATOR Michelle Schaffer physical therapists, to improve the identification, prevention, treatment, and rehabilitation of sports injuries. This newsletter is also available on the Society’s website at www.sportsmed.org. AOSSM MEDICAL PUBLISHING GROUP TO CONTACT THE SOCIETY: American Orthopaedic Society for Sports Medicine, 6300 North River Road, Suite 500, Rosemont, IL 60018, MPG EXEC EDITOR & AJSM EDITOR-IN-CHIEF Bruce Reider MD Phone: 847/292-4900, Fax: 847/292-4905. AJSM SENIOR EDITORIAL/PROD MANAGER Donna Tilton FROM THE PRESIDENT Christopher D. Harner, MD EDUCATION IS THE LIFE BLOOD FOR THE ORTHOPAEDIC SPORTS MEDICINE PROFESSION, and AOSSM continues to provide a broad array of accredited CME programs to support the professions’ expanding needs. While the Society’s 2012 Annual Meeting, which was profiled in the July/August Sports Medicine Update, is our educational crown jewel, AOSSM continues to produce a steady stream of other educational programs for its members. On August 10–12, the Society held the 6th AOSSM & AAOS requirements. In August, the Society received word from Review Course for Subspecialty Certification in Orthopaedic the ABOS that our first Performance Improvement (PI-CME) Sports Medicine in Chicago, chaired by George Paletta, MD, module on patellofemoral pain was approved for MOC Part IV. and Michael Stuart, MD. Since it was first offered, the course In the upcoming months the Society will be working with the has established a sterling reputation for its comprehensive ABOS to integrate the program as a way of providing members program, renowned faculty, innovative approach, and value. This with an option for fulfilling their MOC Part IV requirements. year was no exception and included the AOSSM self-assessment The Society is indebted to William Grana, MD, for developing exam, imaging-arthroscopy correlation sessions modeled after the PIM and launching the Society’s work on this new and the ABOS imaging questions, and online access to all of the critical educational endeavor. program sessions after the meeting. Finally, as the Society and AANA enter their fifth year Just two weeks later, the Society and the NHL Team Physicians of the Orthopaedic Sports Medicine and Arthroscopy Match, Society, with support from the National Hockey League and the I am pleased that 92 accredited fellowship programs are again NHL Players Association, sponsored our tri-annual hockey course participating in the match, affording residents more than in Toronto, Canada, titled Keep Your Edge: Hockey Sports Medicine 217 positions from which to consider and rank for fellowship in 2012. The co-chairs, Benjamin Shaffer, MD, and Michael training. The ongoing strength of the Match underscores Stuart, MD, put together a program and faculty who drew the commitment of the sports medicine community to work a record attendance, featured Gary Bettman, the Commissioner together in providing a strong and stable environment for of the NHL, and included a night at the Hockey Hall of Fame. fellowship training. The meeting underscores AOSSM’s collaborative approach As president, I’m proud of the Society’s ability to continue in bringing the latest scientific knowledge to clinicians. developing fresh, innovative programs that support the profession, While meetings have been the mainstay of AOSSM’s and as an educator I am especially pleased with AOSSM’s educational program, the Society continues to develop new options continued emphasis on quality education. for fulfilling members’ interests and needs. The Self-Assessment Exam has been popular not just for subspecialty certification but also for fulfilling members’ ABOS Maintenance of Certification September/October 2012 SPORTS MEDICINE UPDATE 1 TEAM PHYSICIAN’S CORNER BLUNT EYE INJURIES ROBERT A. GALLO, MD Department of Orthopedics Despite advances in protective eye wear, DAVID LIANG, MD Department of Opthalmology traumatic eye injury remains the second most common T. SHANE JOHNSON, MD cause of visual impairment, behind only cataracts. Each Division of Plastic Surgery, Department of Surgery MATTHEW L. SILVIS, MD year, nearly 15 percent of the 2.5 million eye injuries Department of Orthopedics in the United States occur during sporting activities.1 Department of Family and Community Medicine Pennsylvania State University College of Medicine Of these injuries, 42,000 are severe enough to warrant Milton S. Hershey Medical Center, an emergency department visit, and approximately Hershey, Pennsylvania 13,500 result in legal blindness.2 Continued on page 3 2 SPORTS MEDICINE UPDATE September/October 2012 While many of these injuries involve fat provide structural support and static Evaluation recreational athletes, an estimated one protection while the eyelids dynamically The physical examination of an athlete in 18 college athletes suffers an eye injury protect against injury to the eye. Arising with an acute eye injury begins with each year.3 Athletes who are particularly from the orbit and inserting on the globe, a focused history which includes the vulnerable to injury are those participating extraocular muscles allow for ocular object causing the injury and the force and in sports that involve hard and/or fast- mobility. A complete listing of extraocular direction of impact. Most eye injuries in moving projectiles (e.g., squash, baseball), muscles, their innervations and functions sports occur secondary to blunt, penetrating, sticks (e.g., hockey, lacrosse), close contact are listed in Table I. or radiating trauma. A direct blow to the (e.g., basketball, football, wrestling), The outer coat of the globe consists globe from an object smaller than the eye and intentional injury (e.g., martial arts, of the sclera and cornea, a transparent or orbital opening leads to a rapid increase boxing). Among athletes 5–14 years area on the anterior portion of the eye in anterior-posterior compression and of age, ocular injury most commonly wall, and can be conceptually divided dilation of the middle of the globe. occurs in baseball; in those 15–64 years into two segments. The anterior segment This injury damages the internal ocular of age, basketball is the leading cause consists of: (a) cornea, (b) iris, controls structures. A direct blow with an object of eye injury in sports.4 the amount of light passing into the eye, larger in size than the orbital opening Because of the ubiquity of eye injury (c) ciliary body, produces of aqueous tends to fracture the floor or medial among all types of athletes, knowledge fluid, (d) lens.5 The structures of wall of the orbit and has a high incidence of fundamentals of evaluation and acute the anterior segment are responsible of occult internal ocular injury.4 treatment of blunt eye injury is mandatory for modifying the light/image that Several subjective complaints are for team physicians. The purpose of this is presented to retina. The posterior associated with more severe injury: review is to provide a framework for segment consists of the vitreous humor,
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